3.A.Radiology of the NECK (13).pptx

PowerPoint Presentation

Learning ObjectiveTo correlate bone with the X Ray. To identify the bone and joint in X-ray.To know the different views of the X ray.To identify the different arteries in the angiography.To identify the different structures in the CT scan and MRIRadiological Anatomy

Medical Imaging of the NeckTo visualize these bones, the neck is extended so that the occiput and maxillary teeth are in the same plane.

Radiograph of middle and lower cervical region of vertebral column. The shadows of the pharynx and trachea (dashed line) are superimposed.RadiographyStandard radiographic examinations of the cervical vertebral column include anteroposterior (AP), lateral, and oblique projections. In a routine AP projection of the cervical vertebral column, the mandible usually obscures the first two cervical vertebrae.

Open-mouth radiograph of dens. The dens projects superiorly from the body of the axis (C2 vertebra), around which the atlas (C1 vertebra) rotates.Central X-ray beam aims through the open mouth, perpendicular to the X-ray detector or film cassette.

Radiograph shows:Relationship of the atlas to the axis.

Lateral masses of the atlas are triangular or wedge shaped and are easy to recognize.

Laterally, the long transverse processes of the atlas are clearly visible.

Between the lateral masses of the atlas, the dens of the axis is also readily discernible.

Radiograph of cervical vertebral column. The long spinous process of vertebra C7 is typically the most prominent superficially. Zygapophysial (facet) joints are also visible.Lateral projection of the cervical vertebral column:Person is usually sitting erect, with the neck slightly extended .

Central X-ray beam aims perpendicular to the X-ray detector or film cassette at the level of the thyroid cartilage. Observe the anterior and posterior margins of the vertebral bodies.

Observe the IV disc spaces are wider anteriorly than posteriorly, indicating that the IV discs are wedge shaped.

As the discs degenerate, the vertical height of the disc spaces decreases.

Observe the long, prominent spinous process of vertebra C7.

Radiograph of esophagus. This radiograph was taken after barium was swallowed. Necklaces should be removed before radiographs are taken.Contrast visualization of the esophagus is achieved by having the patient swallow a mixture of barium sulfate and water . First constrictions in the esophagus occurs at the pharyngoesophageal junction. Commencement of the esophagus is its narrowest part.

Computed TomographyTransverse CT scans through the thyroid gland show sections of the neck. They are oriented to show how a horizontal section of the person's neck appears to the physician standing at the foot of the bed. The superior edge of the CT image represents the anterior surface of the neck, and the right lateral edge of the image represents the left lateral surface. CT is used mainly as a diagnostic adjunct to conventional radiography. CT scans are superior to radiographs because they reveal radiodensity differences among and within soft tissues (e.g., the thyroid gland).

Transverse scans of neck through thyroid gland. A CT study through the lobes of the thyroid gland is shown. An MRI study through the thyroid isthmus is shown. 1. Esophagus 2. Trachea 3. Lobes of the thyroid gland 4. Thyroid isthmus 5. SCM6. Sternohyoid muscles7. Common carotid artery8. IJV9. Vertebral artery10. Vertebral body11. Spinal cord surrounded by cerebrospinal fluid in the subarachnoid space12. Deep muscles of the back13. Retropharyngeal space.

Magnetic Resonance ImagingMRI systems construct images of transverse, sagittal, and coronal sections of the neck and have the advantage of using no radiation.

MRI studies of the neck are superior to CT studies for showing detail in the soft tissues, but they provide little information about bones.

Median MRI study of floor of mouth and neck. The tongue, oropharynx, hyoid, thyroid and cricoid cartilages, vocal fold, and trachea are visible.

Coronal MRI study of larynx. The valleculae of the oropharynx, piriform fossae of the laryngopharynx, and vestibular and vocal folds of the larynx are visible.

UltrasonographyUseful diagnostic imaging technique for studying the soft tissues of the neck.

Provides images of many abnormal conditions of the neck non-invasively, at relatively low cost, and with minimal discomfort.

Useful for distinguishing solid from cystic masses, for example, which may be difficult to determine during physical examinations.

Vascular imaging of arteries and veins of the neck is possible using intravascular ultrasonography.

The images are produced by placing a transducer within a blood vessel.

Doppler ultrasound techniques help evaluate blood flow through a vessel, for detecting stenosis of a carotid artery, for example.

Doppler color flow study of internal carotid artery. The study reveals normal blood flow.

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